Is HPV Vaccine Benefit Exaggerated?
Experts Debate Whether Gardasil Marketing Clouds Risk/Benefit Decision
HPV Vaccine, Pap Screens, and Cervical Cancer continued...
Haug notes that the U.S. women who get cervical cancer are those with the
least access to health care. Those who get regular Pap tests, she says, are
unlikely to get cervical cancer even if they don't get vaccinated against
"We already have a way of preventing cervical cancer -- that is a major
point, at least for those of us lucky enough to have health care and use it. So
this can be prevented without the vaccine," Haug says.
That's not entirely true, says Haupt.
"While Pap screening is a very important intervention, it is not perfect.
Not all women get Pap testing, and not all women who get Pap tests will have
their lesions found," Haupt tells WebMD. "And even with 50 years of Pap
testing, we see 30 cases of cervical cancer a day in the U.S. Vaccination is
another tool that together with Pap screening will contribute to cancer
prevention. Neither one works as well without the other."
"We still have people dying of cervical cancer here in the U.S.," Englund
says. "It is easy to say we can prevent cervical cancer with Pap screening, but
people are not getting Pap screens: minority women, our native people, poorer
people. So when you talk of risks and benefits, people must realize that some
don't have the benefit of having the wonderful health care I enjoy because I
have health insurance. But they still have the risk of cervical cancer."
A CDC report -- appearing in the in the same issue of The Journal of the
American Medical Association -- summarizes adverse events associated with
Gardasil from its June 2006 approval through December 2008.
The report finds only one major safety issue worthy of further study: There
might be a higher-than-expected number of blood clots in women who received the
Study leader Barbara A. Slade, MD, a medical officer at the CDC, notes that
the reports do not prove a link between the vaccine and adverse events. The
reports do, however, point to potential risks that require further study.
"This is something worth looking at," Slade tells WebMD. "Now nearly all the
people with blood clots had one of the known risks: estrogen birth control,
obesity, one of the genetic mutations that puts you at risk. Most had one if
not more than one of these risks."
Further study will be needed to show whether these blood clots are actually
caused by the vaccine; such studies already are under way.